INFLUENCE OF SOCIO-DEMOGRAPHIC FACTORS ON ADHERENCE OF PATIENTS WITH TYPE 2 DIABETES IN A PRIMARY HEALTHCARE SETTING IN WESTERN BOSNIA AND HERCEGOVINA

Diabetes mellitus, including type 2 diabetes, is a global health issue with less than 50% of individuals achieving optimal glycemic control. A study at Health Center Krupa na Uni, Republic Srpska, assessed adherence in 159 adults with type 2 diabetes, during the study conducted during 2019-2020. The research used a general and specific questionnaire The Adherence in Chronic Diseases Scale. Findings showed 72.9% had moderate adherence, 16.4% had low adherence, and only 10.7% had high adherence. The female gender predicted higher adherence (p=0.048). The type of oral hypoglycemic agents (p=0.520) was not associated with adherence. Older age (p=0.316) and lower education level (p=0.182) were associated with lower adherence, but not significantly. Age over 60 years and level of education had no significant effects on adherence. Although there was no statistical significance, employed respondents (p=0.076) and those living in rural areas had a higher level of adherence (p=0.064). Some respondents took medications based on their physical needs and beliefs, indicating the need to address beliefs and behaviors influencing adherence. Poor adherence remains a significant issue, and addressing adherence barriers, particularly those related to gender, can improve health outcomes for individuals with type 2 diabetes. Ongoing research and interventions are crucial to improve adherence rates and health outcomes in individuals with type 2 diabetes

Frequency of depression in patients affected by subclinical and clinical hypothyroidism: A cross-section study

Introduction. Hypothyroidism can be accompanied by various neuropsychiatric manifestations ranging from mild depression and anxiety to psychosis. Objective. The study aimed to determine the presence of depression in patients with hypothyroidism (clinical and subclinical). Methods. The survey was conducted over twenty-four months, from 01. 07. 2017. to 01. 07. 2019., at the Health Center Krupa na Uni. The cross-sectional study included 160 persons, two groups of 80 persons each. The first group included those with newly diagnosed hypothyroidism, while the control group consisted of people with neat, thyroid function. In addition to the general questionnaire, the study used Beck's Depression Inventory and laboratory analyzes (enzymatic assays to determine thyroid stimulating hormone and thyroxine). The chi-square test was used in the statistical analysis. Results. The first group consisted of 62 (38.7%) subjects with subclinical hypothyroidism and 18 (11.3%) with clinical hypothyroidism, 51 (63.7%) women and 29 (36.3%) men with a mean age of 52±6.9 years. The control group consisted of 42 (52.5%) women and 38 (47.5%) men, with a mean age of 51±4.3 years. Mild depression was verified in 50 (31.2%), moderately severe in 43 (26.9%), and severe depression in 3 (1.9%). The study found the existence of statistically significantly moderate-severe depression in participants with subclinical hypothyroidism (p<0.05). Conclusion. The results of our study indicate a statistically significantly presence of moderately severe depression in patients with subclinical hypothyroidism. Early detection and adequate therapeutic intervention of thyroid gland disorders in patients with depression. Our findings favor the need for early and routine screening for hypothyroidism and depression

COULD IT BE BEHÇET'S DISEASE? PHYSICIANS IN PRIMARY HEALTHCARE ARE THE FIRST TO RESPOND

Behçet's disease is a chronic relapsing vasculitis with complex immunopathogenesis that can affect multiple organs, although mucocutaneous lesions are predominantly observed. Diagnosis of Behçet's disease is challenging and relies on clinical manifestations as no specific laboratory test is available. A positive Pathergy test should raise suspicion of Behçet's disease. The authors present a clinical case of a 22-year-old woman who presented with intermittent fever, weight loss, odynophagia, dysphagia, left knee arthritis, and multiple painful oral-genital aphthosis. The patient received treatment with benzydamine hydrochloride mouthwash, lidocaine on ulcers, antibiotics, and non-steroidal anti-inflammatory drugs, but the healing process was slow, and a new disease attack occurred two months later. The Pathergy test was performed and found to be positive, prompting consultation with an immunologist and gynecologist. The patient was administered Colchicine (1.5 mg/day), which resulted in decreased symptoms, albeit with a slow healing process. During the 6-month follow-up period, the disease attack was followed by a period of remission. The evidence base for the treatment of Behçet's disease is limited, and current options include symptomatic, non-biological, and biological immunosuppressive drugs to reduce clinical manifestations. A thorough evaluation and education in primary healthcare settings are crucial to facilitate timely multidisciplinary referrals for effective management of Behçet's disease

Air pollution and its impact on human health: An overview of the situation in the Republic of Serbia

Air pollution has become a major global concern with profound implications for public health worldwide. Among the most significant air pollutants are particulate matter, sulfur dioxide, nitrogen oxides, heavy metals, and ammonia, which have serious and wide-ranging effects on human health. Respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and pneumonia, are frequently associated with air pollution, while the risk of developing other serious conditions such as diabetes and cardiovascular problems is also elevated. Of particular concern is the exposure of children to air pollution, as their immune systems are not fully developed, and they spend more time outdoors, where pollution concentrations are often higher. In Serbia, as in many other countries, integrated intersectoral measures are necessary to reduce air pollution and protect the health of citizens. This paper aims to provide a basic overview of air pollution issues in Serbia and explore control and measurement measures to better understand the fundamental concepts and make progress in addressing this serious problem

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics